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Mladenić T, Mavrinac M, Dević Pavlić S, Malnar A, Matić M, Mikić S, Ostojić S, Pereza N. Non-genetic physicians' knowledge, attitudes and behavior towards medical genetics. Wien Klin Wochenschr 2024; 136:137-145. [PMID: 36763136 DOI: 10.1007/s00508-023-02152-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/08/2023] [Indexed: 02/11/2023]
Abstract
To examine the knowledge, behavior, and attitudes toward medical genetics among obstetrics and gynecology, pediatrics, and neurology residents and specialists, who encounter the highest number of patients with specific genetic disorders, in their everyday practice. The cross-sectional study involved 182 nongenetic residents and specialists in the Republic of Croatia, who completed a validated online questionnaire anonymously and voluntarily. The questionnaire consisted of five groups of questions: general information, knowledge, behavior in practice, attitude toward genetic testing, and additional education in medical genetics. The median score for overall knowledge of medical genetics was 70.2% among obstetrician-gynecologists, 80.5% among pediatricians, and 76.7% among neurologists (P < 0.001, lowest median in obstetrician-gynecologists). When asked about their behavior in daily practice, around 90% of respondents admitted the possibility of not recognizing patients with genetic disorders, which is why more than 90% emphasized the need for additional education in medical genetics. In addition, the respondents showed a positive attitude toward genetic testing, but they did not feel educated enough to interpret the results of genetic testing. The results highlight the need for further genetic education of non-genetic health professionals, which would lead to greater confidence and ability to recognize patients with genetic disorders, select the appropriate genetic testing method and achieve more efficient communication with patients.
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Affiliation(s)
- Tea Mladenić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Martina Mavrinac
- Department of Medical Informatics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sanja Dević Pavlić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Anna Malnar
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Matea Matić
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Sara Mikić
- Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Saša Ostojić
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
| | - Nina Pereza
- Center for genetic education, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
- Department of Medical Biology and Genetics, Faculty of Medicine, University of Rijeka, Rijeka, Croatia.
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2
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Lipov A, Jurgens SJ, Mazzarotto F, Allouba M, Pirruccello JP, Aguib Y, Gennarelli M, Yacoub MH, Ellinor PT, Bezzina CR, Walsh R. Exploring the complex spectrum of dominance and recessiveness in genetic cardiomyopathies. Nat Cardiovasc Res 2023; 2:1078-1094. [PMID: 38666070 PMCID: PMC11041721 DOI: 10.1038/s44161-023-00346-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/07/2023] [Indexed: 04/28/2024]
Abstract
Discrete categorization of Mendelian disease genes into dominant and recessive models often oversimplifies their underlying genetic architecture. Cardiomyopathies (CMs) are genetic diseases with complex etiologies for which an increasing number of recessive associations have recently been proposed. Here, we comprehensively analyze all published evidence pertaining to biallelic variation associated with CM phenotypes to identify high-confidence recessive genes and explore the spectrum of monoallelic and biallelic variant effects in established recessive and dominant disease genes. We classify 18 genes with robust recessive association with CMs, largely characterized by dilated phenotypes, early disease onset and severe outcomes. Several of these genes have monoallelic association with disease outcomes and cardiac traits in the UK Biobank, including LMOD2 and ALPK3 with dilated and hypertrophic CM, respectively. Our data provide insights into the complex spectrum of dominance and recessiveness in genetic heart disease and demonstrate how such approaches enable the discovery of unexplored genetic associations.
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Affiliation(s)
- Alex Lipov
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
| | - Sean J. Jurgens
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | - Francesco Mazzarotto
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Mona Allouba
- National Heart and Lung Institute, Imperial College London, London, UK
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - James P. Pirruccello
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA USA
- Division of Cardiology, University of California, San Francisco, San Francisco, CA USA
| | - Yasmine Aguib
- National Heart and Lung Institute, Imperial College London, London, UK
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
| | - Massimo Gennarelli
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy
- Genetics Unit, Istituto di Ricovero e Cura a Carattere Scientifico, Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - Magdi H. Yacoub
- National Heart and Lung Institute, Imperial College London, London, UK
- Aswan Heart Centre, Magdi Yacoub Heart Foundation, Aswan, Egypt
- Harefield Heart Science Centre, Uxbridge, UK
| | - Patrick T. Ellinor
- Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, MA USA
- Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
- Demoulas Center for Cardiac Arrhythmias, Massachusetts General Hospital, Boston, MA USA
| | - Connie R. Bezzina
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart, Amsterdam, the Netherlands
| | - Roddy Walsh
- Department of Experimental Cardiology, Heart Centre, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Cardiovascular Sciences, Heart Failure & Arrhythmias, Amsterdam, the Netherlands
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3
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Cheema AW, Sutton EJ, Beck AT, Cuellar I, Moreno Garzon GG, Hernandez V, Lindor NM, Shaibi GQ, Kullo IJ, Sharp RR. Experiences of Latino Participants Receiving Neutral Genomic Screening Results: A Qualitative Study. Public Health Genomics 2021; 24:44-53. [PMID: 33592611 PMCID: PMC10291848 DOI: 10.1159/000513219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The aim of the study was to characterize experiences of Latino participants receiving genomic screening results. METHODS Participants were recruited at a federally qualified health center in the USA. In-person, semi-structured interviews were conducted in either Spanish or English by a bilingual, bicultural interviewer. Questions focused on motivations for pursuing genomic sequencing, concerns about receiving genomic screening results, and perceived benefits of receiving genomic information. Interviews were audio-recorded, transcribed, and translated. RESULTS Fifty individuals completed an interview; 39 were conducted in Spanish. Participants described mixed motivations for pursuing genomic screening. Participants viewed the benefits of genomic screening in relation to not only their personal health but to the health of their families and their communities. Participants tended to have few concerns about genomic screening. Those concerns related to potential loss of privacy, misuses of genomic information, and the possibility of receiving distressing results. Some participants had misunderstandings about the scope of the test and the potential implications of their results. Most felt it was better to know about a genetic predisposition to disease than to remain uninformed. Participants felt that genomic screening was worthwhile. DISCUSSION This is one of the first studies to examine the experiences of Latino individuals receiving genomic screening results. Our results suggest that many Latino patients in the US see value in genomic screening and have limited concerns about its potential to cause harm. These results inform ongoing efforts to increase the availability of genomic medicine to underrepresented populations and add to our understanding of sociocultural drivers in the adoption of precision medicine.
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Affiliation(s)
- Amal W Cheema
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Erica J Sutton
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Annika T Beck
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA
| | - Idali Cuellar
- Biospecimens Accessioning and Processing, Mayo Clinic, Scottsdale, Arizona, USA
| | | | | | - Noralane M Lindor
- Department of Health Sciences Research, Mayo Clinic, Scottsdale, Arizona, USA
| | - Gabriel Q Shaibi
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
| | - Iftikhar J Kullo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard R Sharp
- Biomedical Ethics Research Program, Mayo Clinic, Rochester, Minnesota, USA,
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA,
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Hong JH, Chong ST, Lee PH, Tan J, Heng HL, Ishak NDB, Chan SH, Teh BT, Ngeow J. Functional characterisation guides classification of novel BAP1 germline variants. NPJ Genom Med 2020; 5:50. [PMID: 33240524 PMCID: PMC7678838 DOI: 10.1038/s41525-020-00157-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022] Open
Abstract
We have identified six patients harbouring distinct germline BAP1 mutations. In this study, we functionally characterise known BAP1 pathogenic and likely benign germline variants out of these six patients to aid in the evaluation and classification of unknown BAP1 germline variants. We found that pathogenic germline variants tend to encode truncated proteins, show diminished expression of epithelial-mesenchymal transition (EMT) markers, are localised in the cytosol and have reduced deubiquitinase capabilities. We show that these functional assays are useful for BAP1 variant curation and may be added in the American College of Medical Genetics and Genomics (ACMG) criteria for BAP1 variant classification. This will allow clinicians to distinguish between BAP1 pathogenic and likely benign variants reliably and may aid to quickly benchmark newly identified BAP1 germline variants. Classification of novel BAP1 germline variants allows clinicians to inform predisposed patients and relevant family members regarding potential cancer risks, with appropriate clinical interventions implemented if required.
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Affiliation(s)
- Jing Han Hong
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore, 169857 Singapore
- Institute of Molecular and Cellular Biology, Agency for Science, Technology and Research, Singapore, 138673 Singapore
| | - Siao Ting Chong
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center, Singapore, 169610 Singapore
| | - Po-Hsien Lee
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, 138672 Singapore
| | - Jing Tan
- Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, 510060 Guangzhou, Guangdong China
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610 Singapore
| | - Hong Lee Heng
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore, 169857 Singapore
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610 Singapore
| | - Nur Diana Binte Ishak
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center, Singapore, 169610 Singapore
| | - Sock Hoai Chan
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center, Singapore, 169610 Singapore
| | - Bin Tean Teh
- Cancer and Stem Cell Biology Program, Duke-NUS Medical School, Singapore, 169857 Singapore
- Institute of Molecular and Cellular Biology, Agency for Science, Technology and Research, Singapore, 138673 Singapore
- Cancer Science Institute of Singapore, National University of Singapore, Singapore, 117599 Singapore
- Genome Institute of Singapore, Agency for Science, Technology and Research, Singapore, 138672 Singapore
- Laboratory of Cancer Epigenome, Division of Medical Sciences, National Cancer Centre Singapore, Singapore, 169610 Singapore
- SingHealth/Duke-NUS Institute of Precision Medicine, National Heart Centre, Singapore, Singapore
| | - Joanne Ngeow
- Institute of Molecular and Cellular Biology, Agency for Science, Technology and Research, Singapore, 138673 Singapore
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Center, Singapore, 169610 Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 308232 Singapore
- Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, 169857 Singapore
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Ross SB, Singer ES, Driscoll E, Nowak N, Yeates L, Puranik R, Sy RW, Rajagopalan S, Barratt A, Ingles J, Bagnall RD, Semsarian C. Genetic architecture of left ventricular noncompaction in adults. Hum Genome Var 2020; 7:33. [PMID: 33082984 PMCID: PMC7566488 DOI: 10.1038/s41439-020-00120-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022] Open
Abstract
The genetic etiology and heritability of left ventricular noncompaction (LVNC) in adults is unclear. This study sought to assess the value of genetic testing in adults with LVNC. Adults diagnosed with LVNC while undergoing screening in the context of a family history of cardiomyopathy were excluded. Clinical data for 35 unrelated patients diagnosed with LVNC at ≥18 years of age were retrospectively analyzed. Left ventricular (LV) dysfunction, electrocardiogram (ECG) abnormalities, cardiac malformations or syndromic features were identified in 25 patients; 10 patients had isolated LVNC in the absence of cardiac dysfunction or syndromic features. Exome sequencing was performed, and analysis using commercial panels targeted 193 nuclear and mitochondrial genes. Nucleotide variants in coding regions or in intron-exon boundaries with predicted impacts on splicing were assessed. Fifty-four rare variants were identified in 35 nuclear genes. Across all 35 LVNC patients, the clinically meaningful genetic diagnostic yield was 9% (3/35), with heterozygous likely pathogenic or pathogenic variants identified in the NKX2-5 and TBX5 genes encoding cardiac transcription factors. No pathogenic variants were identified in patients with isolated LVNC in the absence of cardiac dysfunction or syndromic features. In conclusion, the diagnostic yield of genetic testing in adult index patients with LVNC is low. Genetic testing is most beneficial in LVNC associated with other cardiac and syndromic features, in which it can facilitate correct diagnoses, and least useful in adults with only isolated LVNC without a family history. Cardiac transcription factors are important in the development of LVNC and should be included in genetic testing panels.
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Affiliation(s)
- Samantha Barratt Ross
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Wiser Healthcare, Sydney, Australia
| | - Emma S. Singer
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
| | - Elizabeth Driscoll
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
| | - Natalie Nowak
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
| | - Laura Yeates
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Rajesh Puranik
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Raymond W. Sy
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Alexandra Barratt
- Wiser Healthcare, Sydney, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jodie Ingles
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Wiser Healthcare, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Richard D. Bagnall
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Newtown, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Newtown, Australia
- Wiser Healthcare, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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6
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Chan JY, Toh MR, Chong ST, Ishak NDB, Kolinjivadi AM, Chan SH, Lee E, Boot A, Shao-Tzu L, Chew MH, Ngeow J. Multiple neoplasia in a patient with Gitelman syndrome harboring germline monoallelic MUTYH mutation. NPJ Genom Med 2020; 5:39. [PMID: 33024574 PMCID: PMC7501863 DOI: 10.1038/s41525-020-00146-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 08/19/2020] [Indexed: 12/02/2022] Open
Abstract
Gitelman syndrome is a rare, recessively inherited disease characterized by chronic hypokalemia and hypomagnesemia as a result of defective electrolyte co-transport at the level of the distal convoluted tubule of the kidney. Here, we present the first report of a patient with Gitelman syndrome who developed multiple neoplasia including colorectal polyposis, synchronous colorectal cancers, recurrent breast fibroadenomata and a desmoid tumor. Whole-exome sequencing confirmed germline compound heterozygous mutations of c.179C > T and c.1326C > G in SLC12A3, and in addition, identified a monoallelic germline c.934-2A > G splice site mutation in MUTYH. In vitro, magnesium deficiency potentiated oxidative DNA damage in lymphoblastoid cell lines derived from the same patient. We postulate that monoallelic MUTYH mutations may manifest in the presence of cooperative non-genetic mechanisms, in this case possibly magnesium deficiency from Gitelman syndrome.
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Affiliation(s)
- Jason Yongsheng Chan
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,SingHealth Duke-NUS Blood Cancer Centre, Singapore, Singapore.,Cancer Science Institute of Singapore, National University of Singapore, Singapore, Singapore
| | - Ming Ren Toh
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Siao Ting Chong
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Nur Diana Binte Ishak
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Arun Mouli Kolinjivadi
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Sock Hoai Chan
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Elizabeth Lee
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Arnoud Boot
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore.,Programme in Cancer and Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Li Shao-Tzu
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Min-Hoe Chew
- Department of General Surgery, Sengkang Health, Singapore, Singapore
| | - Joanne Ngeow
- Cancer Genetics Service, Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.,NUS Graduate School for Integrative Sciences and Engineering, Singapore, Singapore.,Oncology Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore.,Institute of Molecular and Cellular Biology, ASTAR, Singapore, Singapore
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Cheema H, Bertoli-Avella AM, Skrahina V, Anjum MN, Waheed N, Saeed A, Beetz C, Perez-Lopez J, Rocha ME, Alawbathani S, Pereira C, Hovakimyan M, Patric IRP, Paknia O, Ameziane N, Cozma C, Bauer P, Rolfs A. Genomic testing in 1019 individuals from 349 Pakistani families results in high diagnostic yield and clinical utility. NPJ Genom Med 2020; 5:44. [PMID: 33083013 DOI: 10.1038/s41525-020-00150-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/06/2020] [Indexed: 11/08/2022] Open
Abstract
We implemented a collaborative diagnostic program in Lahore (Pakistan) aiming to establish the genetic diagnosis, and to asses diagnostic yield and clinical impact in patients with suspected genetic diseases. Local physicians ascertained pediatric patients who had no previous access to genetic testing. More than 1586 genetic tests were performed in 1019 individuals (349 index cases, 670 relatives). Most frequently performed tests were exome/genome sequencing (ES/GS, 284/78 index cases) and specific gene panels (55 index cases). In 61.3% of the patients (n = 214) a genetic diagnosis was established based on pathogenic and likely pathogenic variants. Diagnostic yield was higher in consanguineous families (60.1 vs. 39.5%). In 27 patients, genetic diagnosis relied on additional biochemical testing, allowing rapid assessment of the functional effect of the variants. Remarkably, the genetic diagnosis had a direct impact on clinical management. Most relevant consequences were therapy related such as initiation of the appropriated treatment in a timely manner in 51.9% of the patients (n = 111). Finally, we report 12 candidate genes among 66 cases with no genetic diagnosis. Importantly, three of these genes were validated as 'diagnostic' genes given the strong evidence supporting causality derived from our data repository (CAP2-dilated cardiomyopathy, ITFG2-intellectual disability and USP53-liver cholestasis). The high diagnostic yield, clinical impact, and research findings demonstrate the utility of genomic testing, especially when used as first-line genetic test. For patients with suspected genetic diseases from resource-limited regions, ES can be considered as the test of choice to achieve genetic diagnosis.
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Romero VI, Pozo JC, Saenz S, Llamos-Paneque A, Liehr T, Hosomichi K, Tajima A. A toddler with phylloid-type pigmentary mosaicism and ambiguous genitalia resulting from trisomy 14 induced by a der(Y)t(Y;14). Hum Genome Var 2020; 7:28. [PMID: 33062287 PMCID: PMC7519037 DOI: 10.1038/s41439-020-00113-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/14/2020] [Accepted: 07/15/2020] [Indexed: 11/23/2022] Open
Abstract
A 1-year-old baby with phylloid-type pigmentary mosaicism, hypotonia, ambiguous genitalia, and a positive screening test for congenital adrenal hyperplasia was referred. Previous sonograph, cytogenetics, and metabolic profile were inconclusive, therefore we performed an additional karyotype and a molecular cytogenetics studies. A mosaic karyotype 45,X/46,X,der(Y)t(Y;14) was characterized in peripheral blood. Congenital adrenal hyperplasia genes were sequenced and the results were negative. The ambiguous genitalia was the result of the special gonosomal mosaicism. The low level of trisomy 14 led to minor physical characteristics and mild mental retardation; also, Turner syndrome features can be expected rather than severe trisomy 14 stigmata.
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Affiliation(s)
- V. I. Romero
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - J. C. Pozo
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - S. Saenz
- School of Medicine, Universidad San Francisco de Quito, Quito, Ecuador
| | - A. Llamos-Paneque
- Specialty Army Hospital No. 1. Medical Genetic Services, Sciences of Life Faculty, School of Dentistry, International University of Ecuador, Quito, Ecuador
| | - T. Liehr
- Institute of Human Genetics, Jena University Hospital, Friedrich Schiller University, Am Klinikum 1, D-07747 Jena, Germany
| | - K. Hosomichi
- Department of Bioinformatics and Genomics, Kanazawa University, Kanazawa, Japan
| | - A. Tajima
- Department of Bioinformatics and Genomics, Kanazawa University, Kanazawa, Japan
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9
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Fung JLF, Yu MHC, Huang S, Chung CCY, Chan MCY, Pajusalu S, Mak CCY, Hui VCC, Tsang MHY, Yeung KS, Lek M, Chung BHY. A three-year follow-up study evaluating clinical utility of exome sequencing and diagnostic potential of reanalysis. NPJ Genom Med 2020; 5:37. [PMID: 32963807 DOI: 10.1038/s41525-020-00144-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 01/05/2023] Open
Abstract
Exome sequencing (ES) has become one of the important diagnostic tools in clinical genetics with a reported diagnostic rate of 25–58%. Many studies have illustrated the diagnostic and immediate clinical impact of ES. However, up to 75% of individuals remain undiagnosed and there is scarce evidence supporting clinical utility beyond a follow-up period of >1 year. This is a 3-year follow-up analysis to our previous publication by Mak et al. (NPJ Genom. Med. 3:19, 2018), to evaluate the long-term clinical utility of ES and the diagnostic potential of exome reanalysis. The diagnostic yield of the initial study was 41% (43/104). Exome reanalysis in 46 undiagnosed individuals has achieved 12 new diagnoses. The additional yield compared with the initial analysis was at least 12% (increased from 41% to at least 53%). After a median follow-up period of 3.4 years, change in clinical management was observed in 72.2% of the individuals (26/36), leading to positive change in clinical outcome in four individuals (11%). There was a minimum healthcare cost saving of HKD$152,078 (USD$19,497; €17,282) annually for these four individuals. There were a total of six pregnancies from five families within the period. Prenatal diagnosis was performed in four pregnancies; one fetus was affected and resulted in termination. None of the parents underwent preimplantation genetic diagnosis. This 3-year follow-up study demonstrated the long-term clinical utility of ES at individual, familial and health system level, and the promising diagnostic potential of subsequent reanalysis. This highlights the benefits of implementing ES and regular reanalysis in the clinical setting.
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Chen M, Zhang M, Qian Y, Yang Y, Sun Y, Liu B, Wang L, Dong M. Identification of a likely pathogenic structural variation in the LAMA1 gene by Bionano optical mapping. NPJ Genom Med 2020; 5:31. [PMID: 33083009 DOI: 10.1038/s41525-020-0138-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/03/2020] [Indexed: 01/10/2023] Open
Abstract
Recent advances in Bionano optical mapping (BOM) provide a great insight into the determination of structural variants (SVs), but its utility in identification of clinical likely pathogenic variants needs to be further demonstrated and proved. In a family with two consecutive pregnancies affected with ventriculomegaly, a splicing likely pathogenic variant at the LAMA1 locus (NM_005559: c. 4663 + 1 G > C) inherited from the father was identified in the proband by whole-exome sequencing, and no other pathogenic variant associated with the clinical phenotypes was detected. SV analysis by BOM revealed an ~48 kb duplication at the LAMA1 locus in the maternal sample. Real-time quantitative PCR and Sanger sequencing further confirmed the duplication as c.859-153_4806 + 910dup. Based on these variants, we hypothesize that the fetuses have Poretti-Boltshauser syndrome (PBS) presenting with ventriculomegaly. With the ability to determine single nucleotide variants and SVs, the strategy adopted here might be useful to detect cases missed by current routine screening methods. In addition, our study may broaden the phenotypic spectrum of fetuses with PBS.
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11
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Cueto-González AM, Fernández-Cancio M, Fernández-Alvarez P, García-Arumí E, Tizzano EF. Unusual context of CENPJ variants and primary microcephaly: compound heterozygosity and nonconsanguinity in an Argentinian patient. Hum Genome Var 2020; 7:20. [PMID: 32549991 PMCID: PMC7280259 DOI: 10.1038/s41439-020-0105-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 04/20/2020] [Accepted: 04/27/2020] [Indexed: 11/09/2022] Open
Abstract
Primary microcephaly (MCPH) is a genetically heterogeneous disorder showing an autosomal recessive mode of inheritance. Patients with MCPH present head circumference values two or three standard deviations (SDs) significantly below the mean for age- and sex-matched populations. MCPH is associated with a nonprogressive mild to severe intellectual disability, with normal brain structure in most patients, or with a small brain and gyri without visceral malformations. We present the case of an adult patient born from Argentinian nonconsanguineous healthy parents. He had a head circumference >5 SD below the mean, cerebral neuroimaging showing hypoplasia of the corpus callosum, bilateral migration disorder with heterotopia of the sylvian fissure and colpocephaly. The patient was compound heterozygous for pathogenic variants in the CENPJ gene (c.289dupA inherited from his mother and c.1132 C > T inherited from his father). Our patient represents an uncommon situation for the usual known context of CENPJ and MCPH, including family origin (Argentinian), pedigree (nonconsanguineous), and genotype (a compound heterozygous case with two variants predicting a truncated protein). Next-generation sequencing studies applied in a broader spectrum of clinical presentations of MCPH syndromes may discover additional similar patients and families.
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Affiliation(s)
- Anna M. Cueto-González
- Department of Clinical and Molecular Genetics, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Medicine Genetics Group, Vall d´Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
- European Reference Network Craniofacial Anomalies and ENT disorders (ERN CRANIO)(member) and ERN ITHACA (affiliated), Barcelona, Spain
| | - Mónica Fernández-Cancio
- Pediatric Endocrinology Unit, Vall d´Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
| | - Paula Fernández-Alvarez
- Department of Clinical and Molecular Genetics, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Medicine Genetics Group, Vall d´Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Elena García-Arumí
- Department of Clinical and Molecular Genetics, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
- Neuromuscular and Mitochondrial Pathology Group, Vall d’Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
| | - Eduardo F. Tizzano
- Department of Clinical and Molecular Genetics, Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
- Medicine Genetics Group, Vall d´Hebron Research Institute (VHIR), Vall d’Hebron Barcelona Hospital Campus, Autonomous University of Barcelona, Barcelona, Spain
- European Reference Network Craniofacial Anomalies and ENT disorders (ERN CRANIO)(member) and ERN ITHACA (affiliated), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III, Barcelona, Spain
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12
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Hong CS, Vasquez JC, Kundishora AJ, Elsamadicy AA, Beckta JM, Sule A, Marks AM, Leelatian N, Huttner A, Bindra RS, DiLuna ML, Kahle KT, Erson-Omay EZ. Persistent STAG2 mutation despite multimodal therapy in recurrent pediatric glioblastoma. NPJ Genom Med 2020; 5:23. [PMID: 32528726 DOI: 10.1038/s41525-020-0130-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
Similar to their adult counterparts, the prognosis for pediatric patients with high-grade gliomas remains poor. At time of recurrence, treatment options are limited and remain without consensus. This report describes the genetic findings, obtained from whole-exome sequencing of a pediatric patient with glioblastoma who underwent multiple surgical resections and treatment with standard chemoradiation, as well as a novel recombinant poliovirus vaccine therapy. Strikingly, despite the variety of treatments, there was persistence of a tumor clone, characterized by a deleterious STAG2 mutation, whose deficiency in preclinical studies can cause aneuploidy and aberrant mitotic progression, but remains understudied in the clinical setting. There was near elimination of an EGFR mutated and amplified tumor clone after gross total resection, standard chemoradiation, and poliovirus therapy, followed by the emergence of a persistently STAG2 mutated clone, with rare mutations in PTPN11 and BRAF, the latter composed of a novel deleterious mutation previously not reported in pediatric glioblastoma (p.D594G). This was accompanied by a mutation signature shift towards one characterized by increased DNA damage repair defects, consistent with the known underlying STAG2 deficiency. As such, this case represents a novel report following the clinical and genetic progression of a STAG2 mutated glioblastoma, including treatment with a novel and emerging immunotherapy. Although STAG2 deficiency comprises only a small subset of gliomas, this case adds clinical evidence to existing preclinical data supporting a role for STAG2 mutations in gliomagenesis and resistance to standard therapies.
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13
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Yamamoto-Shimojima K, Ono H, Imaizumi T, Yamamoto T. Novel LAMA2 variants identified in a patient with white matter abnormalities. Hum Genome Var 2020; 7:16. [PMID: 32509318 PMCID: PMC7248065 DOI: 10.1038/s41439-020-0103-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/23/2020] [Accepted: 04/24/2020] [Indexed: 11/24/2022] Open
Abstract
Comprehensive genomic analysis was performed in a patient with mild psychomotor developmental delay, elevated creatine kinase, and white matter abnormalities. The results revealed biallelic pathogenic variants in the gene related to merosin-deficient congenital muscular dystrophy, NM_000426.3(LAMA2):c.1338_1339del [p.Gly447Phefs*7] and c.2749 + 2dup, which consist of compound heterozygous involvement with predicted loss-of-function and splicing abnormalities.
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Affiliation(s)
- Keiko Yamamoto-Shimojima
- Japan Society for the Promotion of Science (RPD), Tokyo, Japan
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
- Tokyo Women’s Medical University Institute for Integrated Medical Sciences, Tokyo, Japan
| | - Hiroaki Ono
- Department of Pediatrics, Hiroshima Prefectural Hospital, Hiroshima, Japan
| | - Taichi Imaizumi
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Toshiyuki Yamamoto
- Institute of Medical Genetics, Tokyo Women’s Medical University, Tokyo, Japan
- Tokyo Women’s Medical University Institute for Integrated Medical Sciences, Tokyo, Japan
- Department of Pediatrics, St. Marianna University School of Medicine, Kawasaki, Japan
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14
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Kochan DC, Winkler E, Lindor N, Shaibi GQ, Olson J, Caraballo PJ, Freimuth R, Pacyna JE, Breitkopf CR, Sharp RR, Kullo IJ. Challenges in returning results in a genomic medicine implementation study: the Return of Actionable Variants Empirical (RAVE) study. NPJ Genom Med 2020; 5:19. [PMID: 32377377 DOI: 10.1038/s41525-020-0127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/27/2020] [Indexed: 12/25/2022] Open
Abstract
To inform the process of returning results in genome sequencing studies, we conducted a quantitative and qualitative assessment of challenges encountered during the Return of Actionable Variants Empiric (RAVE) study conducted at Mayo Clinic. Participants (n = 2535, mean age 63 ± 7, 57% female) were sequenced for 68 clinically actionable genes and 14 single nucleotide variants. Of 122 actionable results detected, 118 were returnable; results were returned by a genetic counselor—86 in-person and 12 by phone. Challenges in returning actionable results were encountered in a significant proportion (38%) of the cohort and were related to sequencing and participant contact. Sequencing related challenges (n = 14), affecting 13 participants, included reports revised based on clinical presentation (n = 3); reports requiring corrections (n = 2); mosaicism requiring alternative DNA samples for confirmation (n = 3); and variant re-interpretation due to updated informatics pipelines (n = 6). Participant contact related challenges (n = 44), affecting 38 participants, included nonresponders (n = 20), decedents (n = 1), and previously known results (n = 23). These results should be helpful to investigators preparing for return of results in large-scale genomic sequencing projects.
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15
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Cannovo N, Guarino R, Fedeli P. Ethical and deontological aspects of pediatric biobanks: the situation in Italy. Cell Tissue Bank 2020; 21:469-77. [PMID: 32314114 DOI: 10.1007/s10561-020-09833-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022]
Abstract
While pediatric biobanks are a precious resource for scientific research to improve our understanding of genetic pathologies, the value of these studies should be considered together with the value of the privacy rights of pediatric donors, as they are particularly vulnerable and in many cases unable to discern the meaning of the donation of biological material and the related implications of the research. Thus this work calls for reflection on the numerous ethical and legal issues involved in the development and regulation of these biobanks. In particular, it explores what form of consent best balances the intangible rights of the minor, on the one hand, and the development of technological progress and scientific research, on the other, and examines the implications of the collection of biological material of minors in biobanks. It focuses on solutions to bridge the gaps in current Italian legislation, especially in light of the current lack of attention to the interests of fragile subjects. In addition, this work presents an overview of the pediatric biobanks in Italy.
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16
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Nakama M, Sasai H, Kubota M, Hasegawa Y, Fujiki R, Okuyama T, Ohara O, Fukao T. Novel HADHB mutations in a patient with mitochondrial trifunctional protein deficiency. Hum Genome Var 2020; 7:10. [PMID: 32257295 PMCID: PMC7118068 DOI: 10.1038/s41439-020-0097-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 02/21/2020] [Indexed: 01/02/2023] Open
Abstract
We encountered a patient with mitochondrial trifunctional protein deficiency in whom the corresponding mutations were not identified by a DNA panel for newborn screening for targeted diseases. After diagnosis confirmation by an enzyme assay and immunoblotting using the autopsied liver, the re-evaluation of the panel data indicated a heterozygous deletion of exons 6-9 that was later confirmed at the genomic level. cDNA analysis also identified exonization of the 5' region of intron 9 caused by a deep intronic mutation, c.811 + 82A>G.
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Affiliation(s)
- Mina Nakama
- Clinical Genetics Center, Gifu University Hospital, Gifu, Japan
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Hideo Sasai
- Clinical Genetics Center, Gifu University Hospital, Gifu, Japan
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics & Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Yuki Hasegawa
- Department of Pediatrics, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Ryoji Fujiki
- Department of Applied Genomics, Kazusa DNA Research Institute, Chiba, Japan
| | - Torayuki Okuyama
- Department of Clinical Laboratory Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Osamu Ohara
- Department of Applied Genomics, Kazusa DNA Research Institute, Chiba, Japan
| | - Toshiyuki Fukao
- Clinical Genetics Center, Gifu University Hospital, Gifu, Japan
- Department of Pediatrics, Graduate School of Medicine, Gifu University, Gifu, Japan
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Abstract
The recent success of gene therapy across multiple clinical trials has inspired a great deal of hope regarding the treatment of previously intractable genetic diseases. This optimism has been extended to the prospect of gene therapy for mitochondrial disorders, which are not only particularly severe but also difficult to treat. However, this hope must be tempered by the reality of the mitochondrial organelle, which possesses specific biological properties that complicate genetic manipulation. In this perspective, we will discuss some of these complicating factors, including the unique pathways used to express and import mitochondrial proteins. We will also present some ways in which these challenges can be overcome by genetic manipulation strategies tailored specifically for mitochondrial diseases.
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18
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Bui CB, Duong TTP, Tran VT, Pham TTT, Vu T, Chau GC, Vo TNV, Nguyen V, Trinh DTT, Hoang MV. A novel nonsense mutation of ERCC2 in a Vietnamese family with xeroderma pigmentosum syndrome group D. Hum Genome Var 2020; 7:2. [PMID: 32047639 PMCID: PMC7008115 DOI: 10.1038/s41439-020-0089-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 12/11/2019] [Accepted: 01/09/2020] [Indexed: 11/09/2022] Open
Abstract
Xeroderma pigmentosum (XP) group D, a severe disease often typified by extreme sun sensitivity, can be caused by ERCC2 mutations. ERCC2 encodes an adenosine triphosphate (ATP)-dependent DNA helicase, namely XP group D protein (XPD). The XPD, one of ten subunits of the transcription factor TFIIH, plays a critical role in the nucleotide-excision repair (NER) pathway. Mutations in XPD that affect the NER pathway can lead to neurological degeneration and skin cancer, which are the most common causes of death in XP patients. Here, we present detailed phenotypic information on a Vietnamese family in which four members were affected by XP with extreme sun sensitivity. Genomic analysis revealed a compound heterozygous mutation of ERCC2 that affected family members and single heterozygous mutations in unaffected family members. We identified a novel, nonsense mutation in one allele of ERCC2 (c.1354C > T, p.Q452X) and a known missense mutation in the other allele (c.2048G > A, p.R683Q). Fibroblasts isolated from the compound heterozygous subject also failed to recover from UV-driven DNA damage, thus recapitulating aspects of XP syndrome in vitro. We describe a novel ERCC2 variant that leads to the breakdown of the NER pathway across generations of a family presenting with severe XP.
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Affiliation(s)
- Chi-Bao Bui
- Biomedical Research Center, School of Medicine, Vietnam National University, Ho Chi Minh City, Vietnam
- Functional Genomics Unit, DNA Medical Technology, Ho Chi Minh City, Vietnam
| | | | - Vien The Tran
- Department of Dermatology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Thuy Thanh T. Pham
- Functional Genomics Unit, DNA Medical Technology, Ho Chi Minh City, Vietnam
| | - Tung Vu
- Functional Genomics Unit, DNA Medical Technology, Ho Chi Minh City, Vietnam
| | - Gia Cac Chau
- Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi-do Korea
| | - Thanh-Niem Van Vo
- Center for Molecular Biomedicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Vinh Nguyen
- Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Dieu-Thuong Thi Trinh
- Department of Hematology and Dermatology, University Medical Center 3, Ho Chi Minh City, Vietnam
- Faculty of Traditional Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Minh Van Hoang
- Department of Hematology and Dermatology, University Medical Center 3, Ho Chi Minh City, Vietnam
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Oni-Orisan A, Haldar T, Ranatunga DK, Medina MW, Schaefer C, Krauss RM, Iribarren C, Risch N, Hoffmann TJ. The impact of adjusting for baseline in pharmacogenomic genome-wide association studies of quantitative change. NPJ Genom Med 2020; 5:1. [PMID: 31969989 DOI: 10.1038/s41525-019-0109-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 12/05/2019] [Indexed: 11/30/2022] Open
Abstract
In pharmacogenomic studies of quantitative change, any association between genetic variants and the pretreatment (baseline) measurement can bias the estimate of effect between those variants and drug response. A putative solution is to adjust for baseline. We conducted a series of genome-wide association studies (GWASs) for low-density lipoprotein cholesterol (LDL-C) response to statin therapy in 34,874 participants of the Genetic Epidemiology Research on Adult Health and Aging (GERA) cohort as a case study to investigate the impact of baseline adjustment on results generated from pharmacogenomic studies of quantitative change. Across phenotypes of statin-induced LDL-C change, baseline adjustment identified variants from six loci meeting genome-wide significance (SORT/CELSR2/PSRC1, LPA, SLCO1B1, APOE, APOB, and SMARCA4/LDLR). In contrast, baseline-unadjusted analyses yielded variants from three loci meeting the criteria for genome-wide significance (LPA, APOE, and SLCO1B1). A genome-wide heterogeneity test of baseline versus statin on-treatment LDL-C levels was performed as the definitive test for the true effect of genetic variants on statin-induced LDL-C change. These findings were generally consistent with the models not adjusting for baseline signifying that genome-wide significant hits generated only from baseline-adjusted analyses (SORT/CELSR2/PSRC1, APOB, SMARCA4/LDLR) were likely biased. We then comprehensively reviewed published GWASs of drug-induced quantitative change and discovered that more than half (59%) inappropriately adjusted for baseline. Altogether, we demonstrate that (1) baseline adjustment introduces bias in pharmacogenomic studies of quantitative change and (2) this erroneous methodology is highly prevalent. We conclude that it is critical to avoid this common statistical approach in future pharmacogenomic studies of quantitative change.
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Milko LV, Chen F, Chan K, Brower AM, Agrawal PB, Beggs AH, Berg JS, Brenner SE, Holm IA, Koenig BA, Parad RB, Powell CM, Kingsmore SF. FDA oversight of NSIGHT genomic research: the need for an integrated systems approach to regulation. NPJ Genom Med 2019; 4:32. [PMID: 31839987 PMCID: PMC6904743 DOI: 10.1038/s41525-019-0105-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 11/04/2019] [Indexed: 11/12/2022] Open
Abstract
The National Institutes of Health (NIH) funded the Newborn Sequencing In Genomic medicine and public HealTh (NSIGHT) Consortium to investigate the implications, challenges, and opportunities associated with the possible use of genomic sequence information in the newborn period. Following announcement of the NSIGHT awardees in 2013, the Food and Drug Administration (FDA) contacted investigators and requested that pre-submissions to investigational device exemptions (IDE) be submitted for the use of genomic sequencing under Title 21 of the Code of Federal Regulations (21 CFR) part 812. IDE regulation permits clinical investigation of medical devices that have not been approved by the FDA. To our knowledge, this marked the first time the FDA determined that NIH-funded clinical genomic research projects are subject to IDE regulation. Here, we review the history of and rationale behind FDA oversight of clinical research and the NSIGHT Consortium's experiences in navigating the IDE process. Overall, NSIGHT investigators found that FDA's application of existing IDE regulations and medical device definitions aligned imprecisely with the aims of publicly funded exploratory clinical research protocols. IDE risk assessments by the FDA were similar to, but distinct from, protocol risk assessments conducted by local Institutional Review Boards (IRBs), and had the potential to reflect novel oversight of emerging genomic technologies. However, the pre-IDE and IDE process delayed the start of NSIGHT research studies by an average of 10 months, and significantly limited the scope of investigation in two of the four NIH approved projects. Based on the experience of the NSIGHT Consortium, we conclude that policies and practices governing the development and use of novel genomic technologies in clinical research urgently need clarification in order to mitigate potentially conflicting or redundant oversight by IRBs, NIH, FDA, and state authorities.
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Affiliation(s)
- Laura V. Milko
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Flavia Chen
- Institute for Human Genetics, University of California, San Francisco, CA 94143 USA
- Program in Bioethics, University of California, San Francisco, CA 94118 USA
| | - Kee Chan
- Department of Health Policy and Administration, University of Illinois, Chicago, IL 60612 USA
| | - Amy M. Brower
- American College of Medical Genetics and Genomics, 7101 Wisconsin Avenue Suite 1101, Bethesda, MD 20814 USA
| | - Pankaj B. Agrawal
- Division of Genetics & Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115 USA
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Alan H. Beggs
- Division of Genetics & Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Jonathan S. Berg
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
| | - Steven E. Brenner
- Institute for Human Genetics, University of California, San Francisco, CA 94143 USA
- Department of Plant and Microbial Biology, University of California, Berkeley, CA 94720 USA
| | - Ingrid A. Holm
- Division of Genetics & Genomics, The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, MA 02115 USA
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
| | - Barbara A. Koenig
- Institute for Human Genetics, University of California, San Francisco, CA 94143 USA
- Program in Bioethics, University of California, San Francisco, CA 94118 USA
| | - Richard B. Parad
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115 USA
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, MA 02115 USA
| | - Cynthia M. Powell
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599 USA
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21
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Hata C, Nakaoka H, Xiang Y, Wang D, Yang A, Liu D, Liu F, Zou Q, Zheng K, Inoue I, You H. Exploration of intermediate-sized INDELs by next-generation multigene panel testing in Han Chinese patients with breast cancer. Hum Genome Var 2019; 6:51. [PMID: 31700649 DOI: 10.1038/s41439-019-0080-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/30/2022] Open
Abstract
Multigene panel testing via next-generation sequencing focuses on the detection of small-sized mutations, such as single nucleotide variants and short insertions and deletions (INDELs). However, intermediate-sized INDELs have not been fully explored due to technical difficulties. Here, we performed bioinformatics analyses to identify intermediate-sized INDELs in 54 cancer-related genes from 583 Han Chinese patients with breast cancer. We detected a novel deletion-insertion in a translational variant of PTEN (also known as PTENα) in one patient.
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22
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Takeshita E, Iida A, Abe-Hatano C, Nakagawa E, Sasaki M, Inoue K, Goto YI. Ten novel insertion/deletion variants in MECP2 identified in Japanese patients with Rett syndrome. Hum Genome Var 2019; 6:48. [PMID: 31645986 PMCID: PMC6804785 DOI: 10.1038/s41439-019-0078-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/11/2019] [Accepted: 09/13/2019] [Indexed: 11/09/2022] Open
Abstract
Rett syndrome (RTT) is an X-linked progressive and severe neurological disorder caused by mutations in the gene encoding methyl CpG binding protein 2 (MECP2). Among the 49 typical RTT patients examined, we identified 10 novel and eight known insertion/deletion variants, and 31 known pathogenic variants in MECP2. The pathogenic variants presented here should be a useful resource for examining the correlation between the genotypes and phenotypes of RTT.
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Affiliation(s)
- Eri Takeshita
- 1Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, 187-8551 Japan
| | - Aritoshi Iida
- 2Department of Clinical Genome Analysis, Medical Genome Center, NCNP, Kodaira, Tokyo, 187-8551 Japan
| | - Chihiro Abe-Hatano
- 3Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, NCNP, Kodaira, Tokyo, 187-8551 Japan
| | - Eiji Nakagawa
- 1Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, 187-8551 Japan
| | - Masayuki Sasaki
- 1Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Kodaira, Tokyo, 187-8551 Japan
| | - Ken Inoue
- 3Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, NCNP, Kodaira, Tokyo, 187-8551 Japan
| | - Yu-Ichi Goto
- 3Department of Mental Retardation and Birth Defect Research, National Institute of Neurology, NCNP, Kodaira, Tokyo, 187-8551 Japan.,4Medical Genome Center, NCNP, Kodaira, Tokyo, 187-8551 Japan
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23
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Lee K, Clyne M, Yu W, Lu Z, Khoury MJ. Tracking human genes along the translational continuum. NPJ Genom Med 2019; 4:25. [PMID: 31632691 DOI: 10.1038/s41525-019-0100-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/03/2019] [Indexed: 12/03/2022] Open
Abstract
Understanding the drivers of research on human genes is a critical component to success of translation efforts of genomics into medicine and public health. Using publicly available curated online databases we sought to identify specific genes that are featured in translational genetic research in comparison to all genomics research publications. Articles in the CDC’s Public Health Genomics and Precision Health Knowledge Base were stratified into studies that have moved beyond basic research to population and clinical epidemiologic studies (T1: clinical and population human genome epidemiology research), and studies that evaluate, implement, and assess impact of genes in clinical and public health areas (T2+: beyond bench to bedside). We examined gene counts and numbers of publications within these phases of translation in comparison to all genes from Medline. We are able to highlight those genes that are moving from basic research to clinical and public health translational research, namely in cancer and a few genetic diseases with high penetrance and clinical actionability. Identifying human genes of translational value is an important step towards determining an evidence-based trajectory of the human genome in clinical and public health practice over time.
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24
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Tsurusaki Y, Kuroda Y, Yamanouchi Y, Kondo E, Ouchi K, Kimura Y, Enomoto Y, Aida N, Masuno M, Kurosawa K. Novel USP9X variants in two patients with X-linked intellectual disability. Hum Genome Var 2019; 6:49. [PMID: 31666975 PMCID: PMC6804943 DOI: 10.1038/s41439-019-0081-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 09/16/2019] [Accepted: 09/19/2019] [Indexed: 01/04/2023] Open
Abstract
USP9X variants have been reported in patients with X-linked intellectual disability. Here, we report two female patients with intellectual disability and pigment abnormalities along Blaschko lines. Targeted resequencing identified two novel heterozygous variants, c.4068_4072del (p. (Leu1357Tyrfs*12)) and c.1201C>T (p. (Arg401*)), in USP9X. Our findings provide further evidence that USP9X variants cause intellectual disability.
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Affiliation(s)
- Yoshinori Tsurusaki
- 1Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan.,2Faculty of Nutritional Science, Sagami Women's University, Sagamihara, Japan
| | - Yukiko Kuroda
- 3Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yasuko Yamanouchi
- 4Genetic Counseling Program, Graduate School of Health and Welfare, Kawasaki University of Medical Welfare, Kurashiki, Japan
| | - Eisuke Kondo
- 5Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Kazunobu Ouchi
- 5Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Yuichi Kimura
- 1Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Enomoto
- 1Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Noriko Aida
- 6Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Mitsuo Masuno
- 4Genetic Counseling Program, Graduate School of Health and Welfare, Kawasaki University of Medical Welfare, Kurashiki, Japan.,5Department of Pediatrics, Kawasaki Medical School, Kurashiki, Japan
| | - Kenji Kurosawa
- 3Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
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25
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Rosa M, Chignon A, Li Z, Boulanger MC, Arsenault BJ, Bossé Y, Thériault S, Mathieu P. A Mendelian randomization study of IL6 signaling in cardiovascular diseases, immune-related disorders and longevity. NPJ Genom Med 2019; 4:23. [PMID: 31552141 PMCID: PMC6754413 DOI: 10.1038/s41525-019-0097-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/29/2019] [Indexed: 12/12/2022] Open
Abstract
Growing evidence suggests that inflammation is a significant contributor to different cardiovascular diseases (CVDs). Mendelian randomization (MR) was performed to assess the causal inference between plasma soluble IL6 receptor (sIL6R), a negative regulator of IL6 signaling, and different cardiovascular and immune-related disorders. Cis-MR with multiple instrumental variables showed an inverse association of sIL6R with rheumatoid arthritis, atrial fibrillation, stroke, coronary artery disease, and abdominal aortic aneurysm. However, genetically-determined sIL6R level was positively associated with atopic dermatitis and asthma. Also, sIL6R level was associated with longevity, as evaluated by parental age at death, a heritable trait. Gene-based association analysis with S-PrediXcan by using tissues from GTExV7 showed that IL6R tissue expression-disease pair associations were consistent with the directional effect of IL6 signaling identified in MR. Genetically-determined reduced IL6 signaling lowers the risk of multiple CVDs and is associated with increased longevity, but at the expense of higher atopic risk.
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Affiliation(s)
- Mickael Rosa
- Laboratory of Cardiovascular Pathobiology, Quebec Heart and Lung Institute/Research Center, Department of Surgery, Laval University, Quebec, Canada
| | - Arnaud Chignon
- Laboratory of Cardiovascular Pathobiology, Quebec Heart and Lung Institute/Research Center, Department of Surgery, Laval University, Quebec, Canada
| | - Zhonglin Li
- Laboratory of Cardiovascular Pathobiology, Quebec Heart and Lung Institute/Research Center, Department of Surgery, Laval University, Quebec, Canada
| | - Marie-Chloé Boulanger
- Laboratory of Cardiovascular Pathobiology, Quebec Heart and Lung Institute/Research Center, Department of Surgery, Laval University, Quebec, Canada
| | | | - Yohan Bossé
- Department of Molecular Medicine, Laval University, Quebec, Canada
| | - Sébastien Thériault
- Department of Molecular Biology, Medical Biochemistry and Pathology, Laval University, Quebec, Canada
| | - Patrick Mathieu
- Laboratory of Cardiovascular Pathobiology, Quebec Heart and Lung Institute/Research Center, Department of Surgery, Laval University, Quebec, Canada
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26
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Courtney E, Chok AK, Ting Ang ZL, Shaw T, Li ST, Yuen J, Ngeow J. Impact of free cancer predisposition cascade genetic testing on uptake in Singapore. NPJ Genom Med 2019; 4:22. [PMID: 31531230 DOI: 10.1038/s41525-019-0096-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 08/09/2019] [Indexed: 02/06/2023] Open
Abstract
Cascade testing for cancer predisposition offers a highly efficient and cost-effective method for identifying individuals at increased risk for cancer, in whom targeted interventions can often improve survival. The aim of this study was to determine the impact of free cascade testing on uptake and identify other associated factors. Demographic and clinical data were gathered prospectively for 183 probands found to have a pathogenic variant associated with cancer predisposition and their 826 first-degree relatives (FDRs). The provision of free cascade testing was significantly associated with uptake (21.6% vs 6.1%; χ 2, P < 0.001). Relationship type between FDR and proband and FDR age also demonstrated significant associations, suggesting greater engagement amongst younger generations. Overall, 29.0% (53/183) of families had at least 1 FDR who underwent cascade testing. Of these families, 67.9% (36/53) had an uptake rate of at least 40.0%. Cost is a significant barrier to cascade testing uptake in Singapore. Tailored interventions targeting underrepresented groups and genetic counseling approaches supporting family communication and decision-making are necessary.
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27
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Nakamura Y, Okuno Y, Muramatsu H, Kawai T, Satou K, Ieda D, Hori I, Ohashi K, Negishi Y, Hattori A, Takahashi Y, Kojima S, Saitoh S. A novel CUL4B splice site variant in a young male exhibiting less pronounced features. Hum Genome Var 2019; 6:43. [PMID: 31645981 DOI: 10.1038/s41439-019-0074-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 11/20/2022] Open
Abstract
Patients with variants in CUL4B exhibit syndromic intellectual disability (MIM #300354). A seven-year-old boy presented with intellectual disability, a history of seizure, characteristic facial features, and short stature. Whole-exome sequencing detected a c.974+3A>G variant in CUL4B, which was subsequently confirmed to disrupt mRNA splicing. The current patient showed less pronounced phenotypic features compared with the previously reported cases. This report, therefore, provides evidence of genotype–phenotype correlations in CUL4B-related disorders.
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28
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Ito T, Kawashima Y, Fujikawa T, Honda K, Makabe A, Kitamura K, Tsutsumi T. Rapid screening of copy number variations in STRC by droplet digital PCR in patients with mild-to-moderate hearing loss. Hum Genome Var 2019; 6:41. [PMID: 31645979 PMCID: PMC6804619 DOI: 10.1038/s41439-019-0075-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/09/2022] Open
Abstract
Copy number variations (CNVs) are commonly reported in STRC, the causal gene for DFNB16. Various techniques are used clinically for CNV detection, and droplet digital PCR (ddPCR) provides highly precise absolute quantification of DNA copy number. We aimed to validate the feasibility and efficiency of ddPCR in combination with long-range PCR (LR-PCR) in identifying CNVs and mutations in STRC. Additionally, we determined the frequency of CNVs and mutations in STRC in Japanese patients with mild-to-moderate hearing loss. We evaluated 84 unrelated Japanese patients with mild-to-moderate bilateral idiopathic or autosomal recessive nonsyndromic sensorineural hearing loss. The ratio of STRC copy number to the copy number of the internal control RPP30 ranged from 0.949 to 1.009 (0.989 ± 0.017) in 77 patients; it ranged from 0.484 to 0.538 (0.509 ± 0.024) in five patients and was 0.000 in two patients, indicating heterozygous and homozygous deletions, respectively. The copy number deletion prevalence rates were 7.7% and 0.9% in the patients and healthy controls, respectively. In combination with LR-PCR, ddPCR revealed that at least three patients (3.6%) had STRC-related hearing loss. Detecting STRC CNVs by ddPCR was rapid, precise, and cost-effective and facilitated the identification of STRC CNVs.
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Affiliation(s)
- Taku Ito
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshiyuki Kawashima
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Taro Fujikawa
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiji Honda
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ayane Makabe
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ken Kitamura
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan.,Department of Otorhinolaryngology, Head and Neck Surgery, Chigasaki Chuo Hospital, Chigasaki, Japan
| | - Takeshi Tsutsumi
- 1Department of Otorhinolaryngology, Tokyo Medical and Dental University, Tokyo, Japan
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29
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Ohashi I, Enomoto Y, Naruto T, Tsurusaki Y, Kuroda Y, Ishikawa H, Ohyama M, Aida N, Nishimura G, Kurosawa K. A severe form of Ellis-van Creveld syndrome caused by novel mutations in EVC2. Hum Genome Var 2019; 6:40. [PMID: 31645978 PMCID: PMC6804659 DOI: 10.1038/s41439-019-0071-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Accepted: 07/26/2019] [Indexed: 11/29/2022] Open
Abstract
Ellis-van Creveld syndrome (EvC MIM. #225500) is an autosomal recessive skeletal dysplasia characterised by thoracic hypoplasia, cardiac anomalies, acromesomelic limb shortening, and postaxial polydactyly. Affected individuals commonly manifest with cardiorespiratory failure as neonates but generally survive neonatal difficulties. We report here on affected Japanese sibs with a lethal phenotype of EvC caused by novel compound heterozygous mutations of EVC2, c.871-3 C > G and c.1991dupA.
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Affiliation(s)
- Ikuko Ohashi
- 1Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yumi Enomoto
- 2Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Takuya Naruto
- 2Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yoshinori Tsurusaki
- 2Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yukiko Kuroda
- 1Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Hiroshi Ishikawa
- 3Department of Obstetrics and Gynecology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Makiko Ohyama
- 4Department of Neonatology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Noriko Aida
- 5Department of Radiology, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Gen Nishimura
- 6Intractable Disease Center, Saitama Medical University Hospital, Saitama, Japan
| | - Kenji Kurosawa
- 1Division of Medical Genetics, Kanagawa Children's Medical Center, Yokohama, Japan.,2Clinical Research Institute, Kanagawa Children's Medical Center, Yokohama, Japan
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30
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Tominaga M, Hamanoue S, Goto H, Saito T, Nagai JI, Masuno M, Umeda Y, Kurosawa K. Diamond-Blackfan anemia caused by chromosome 1p22 deletion encompassing RPL5. Hum Genome Var 2019; 6:36. [PMID: 31645974 DOI: 10.1038/s41439-019-0067-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 07/05/2019] [Accepted: 07/07/2019] [Indexed: 11/11/2022] Open
Abstract
Diamond-Blackfan anemia (DBA) is an inherited anemia with multiple congenital malformations, and mutations in ribosomal protein genes have been identified as the underlying cause. We describe a female patient with mild DBA due to 1p22 deletion, encompassing the gene encoding 60S ribosomal protein L5 (RPL5). Considering previously reported cases together with our patient, we suggest that RPL5 haploinsufficiency might cause a less severe form of DBA than loss-of-function mutations.
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31
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Gagunashvili AN, Ocaka L, Kelberman D, Munot P, Bacchelli C, Beales PL, Ganesan V. Novel missense variants in the RNF213 gene from a European family with Moyamoya disease. Hum Genome Var 2019; 6:35. [PMID: 31645973 PMCID: PMC6804521 DOI: 10.1038/s41439-019-0066-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/06/2019] [Accepted: 06/21/2019] [Indexed: 01/30/2023] Open
Abstract
In this report, we present a European family with six individuals affected with Moyamoya disease (MMD). We detected two novel missense variants in the Moyamoya susceptibility gene RNF213, c.12553A>G (p.(Lys4185Glu)) and c.12562G>A (p.(Ala4188Thr)). Cosegregation of the variants with MMD, as well as a previous report of a variant affecting the same amino acid residue in unrelated MMD patients, supports the role of RNF213 in the pathogenesis of MMD.
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Affiliation(s)
- Andrey N Gagunashvili
- 1GOSgene, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Louise Ocaka
- 1GOSgene, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Daniel Kelberman
- 1GOSgene, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Pinki Munot
- 2Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Chiara Bacchelli
- 1GOSgene, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Philip L Beales
- 1GOSgene, Genetics and Genomic Medicine, UCL Great Ormond Street Institute of Child Health, London, UK
| | - Vijeya Ganesan
- 2Neurology Department, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,3Clinical Neurosciences, UCL Great Ormond Street Institute of Child Health, London, UK
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32
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Villela D, Che H, Van Ghelue M, Dehaspe L, Brison N, Van Den Bogaert K, Devriendt K, Lewi L, Bayindir B, Vermeesch JR. Fetal sex determination in twin pregnancies using non-invasive prenatal testing. NPJ Genom Med 2019; 4:15. [PMID: 31285848 PMCID: PMC6609680 DOI: 10.1038/s41525-019-0089-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 05/31/2019] [Indexed: 01/23/2023] Open
Abstract
Non-invasive prenatal testing (NIPT) is accurate for fetal sex determination in singleton pregnancies, but its accuracy is not well established in twin pregnancies. Here, we present an accurate sex prediction model to discriminate fetal sex in both dichorionic diamniotic (DCDA) and monochorionic diamniotic/monochorionic monoamniotic (MCDA/MCMA) twin pregnancies. A retrospective analysis was performed using a total of 198 twin pregnancies with documented sex. The prediction was based on a multinomial logistic regression using the normalized frequency of X and Y chromosomes, and fetal fraction estimation. A second-step regression analysis was applied when one or both twins were predicted to be male. The model determines fetal sex with 100% sensitivity and specificity when both twins are female, and with 98% sensitivity and 95% specificity when a male is present. Since sex determination can be clinically important, implementing fetal sex determination in twins will improve overall twin pregnancies management.
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Affiliation(s)
- Darine Villela
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium.,2Department of Genetics and Evolutionary Biology, Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Huiwen Che
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Marijke Van Ghelue
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium.,3Department of Medical Genetics, Division of Child and Adolescent Health, University Hospital of North Norway, Tromsø, Norway.,4Department of Clinical Medicine, University of Tromsø, Tromsø, Norway
| | - Luc Dehaspe
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium
| | | | | | - Koen Devriendt
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium
| | - Liesbeth Lewi
- 5Clinical Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,6Department of Development and Regeneration, Cluster Woman and Child, Group Biomedical Sciences, KU Leuven, Leuven, Belgium
| | - Baran Bayindir
- 1Department of Human Genetics, KU Leuven, Leuven, Belgium
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33
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Bylstra Y, Davila S, Lim WK, Wu R, Teo JX, Kam S, Lysaght T, Rozen S, Teh BT, Yeo KK, Cook SA, Tan P, Jamuar SS. Implementation of genomics in medical practice to deliver precision medicine for an Asian population. NPJ Genom Med 2019; 4:12. [PMID: 31231544 DOI: 10.1038/s41525-019-0085-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/15/2019] [Indexed: 01/06/2023] Open
Abstract
Whilst the underlying principles of precision medicine are comparable across the globe, genomic references, health practices, costs and discrimination policies differ in Asian settings compared to the reported initiatives involving European-derived populations. We have addressed these variables by developing an evolving reference base of genomic and phenotypic data and a framework to return medically significant variants to consenting research participants applicable for the Asian context. Targeting 10,000 participants, over 2000 Singaporeans, with no known pre-existing health conditions, have consented to an extensive clinical health screen, family health history collection, genome sequencing and ongoing follow-up. Genomic variants in a subset of genes associated with Mendelian disorders and drug responses are analysed using an in-house bioinformatics pipeline. A multidisciplinary team reviews the classification of variants and a research report is generated. Medically significant variants are returned to consenting participants through a bespoke return-of-result genomics clinic. Variant validation and subsequent clinical referral are advised as appropriate. The design and implementation of this flexible learning framework enables a cohort of detailed phenotyping and genotyping of healthy Singaporeans to be established and the frequency of disease-causing variants in this population to be determined. Our findings will contribute to international precision medicine initiatives, bridging gaps with ethnic-specific data and insights from this understudied population.
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Sprute R, Ardicli D, Oguz KK, Malenica-Mandel A, Daimagüler HS, Koy A, Coskun T, Wang H, Topcu M, Cirak S. Clinical outcomes of two patients with a novel pathogenic variant in ASNS: response to asparagine supplementation and review of the literature. Hum Genome Var 2019; 6:24. [PMID: 31123592 PMCID: PMC6531480 DOI: 10.1038/s41439-019-0055-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 03/31/2019] [Accepted: 04/01/2019] [Indexed: 11/09/2022] Open
Abstract
Asparagine synthetase deficiency (ASNSD, OMIM #615574) is a rare autosomal recessive neurometabolic inborn error that leads to severe cognitive impairment. It manifests with microcephaly, intractable seizures, and progressive cerebral atrophy. Currently, there is no established treatment for this condition. In our pediatric cohort, we discovered, by whole-exome sequencing in two siblings from Turkey, a novel homozygous missense mutation in asparagine synthetase at NM_133436.3 (ASNS_v001): c.1108C>T that results in an amino acid exchange p.(Leu370Phe), in the C-terminal domain. After identification of the metabolic defect, treatment with oral asparagine supplementation was attempted in both patients for 24 months. Asparagine supplementation was well tolerated, and no further disease progression was observed during treatment. One of our patients showed mild developmental progress with increased levels of attention and improved nonverbal communication. These results support our hypothesis that asparagine supplementation should be further investigated as a treatment option for ASNSD. We further reviewed all previously reported ASNSD cases with regard for their clinical phenotypes and brain imaging findings to provide an essential knowledge base for rapid diagnosis and future clinical studies.
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Affiliation(s)
- Rosanne Sprute
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany.,2Faculty of Medicine and the Faculty of Mathematics and Natural Sciences, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Didem Ardicli
- 3Department of Pediatric Neurology, Hacettepe University, 06100 Ankara, Turkey
| | - Kader Karli Oguz
- 4Department of Radiology, Hacettepe University, 06100 Ankara, Turkey
| | - Anna Malenica-Mandel
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany.,2Faculty of Medicine and the Faculty of Mathematics and Natural Sciences, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Hülya-Sevcan Daimagüler
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany.,2Faculty of Medicine and the Faculty of Mathematics and Natural Sciences, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Anne Koy
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany
| | - Turgay Coskun
- 5Department of Pediatric Metabolism Unit, Hacettepe University, 06100 Ankara, Turkey
| | - Haicui Wang
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany.,2Faculty of Medicine and the Faculty of Mathematics and Natural Sciences, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
| | - Meral Topcu
- 3Department of Pediatric Neurology, Hacettepe University, 06100 Ankara, Turkey
| | - Sebahattin Cirak
- 1Faculty of Medicine and University Hospital Cologne, Department of Pediatrics, University of Cologne, 50931 Cologne, Germany.,2Faculty of Medicine and the Faculty of Mathematics and Natural Sciences, Center for Molecular Medicine Cologne (CMMC), University of Cologne, 50931 Cologne, Germany
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35
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Uchino S, Iida A, Sato A, Ishikawa K, Mimaki M, Nishino I, Goto YI. A novel compound heterozygous variant of ECHS1 identified in a Japanese patient with Leigh syndrome. Hum Genome Var 2019; 6:19. [PMID: 31016024 PMCID: PMC6474858 DOI: 10.1038/s41439-019-0050-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/25/2022] Open
Abstract
Leigh syndrome (LS) is a heterogeneous neurodegenerative disorder caused by mitochondrial dysfunction. Certain LS cases have mutations in ECHS1, which encodes a short-chain enoyl-CoA hydratase involved in the metabolism of fatty acids and branched-chain amino acids in mitochondria. Using exome sequencing, we diagnosed a Japanese patient with LS and identified the patient as a compound heterozygote for a novel variant of ECHS1, consisting of NM_004092.4:c.23T>C (p.Leu8Pro) and NM_004092.4:c.176A>G (p.Asn59Ser).
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Affiliation(s)
- Shumpei Uchino
- 1Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,2Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan.,3Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Atsushi Sato
- 3Department of Pediatrics, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | | | - Masakazu Mimaki
- 2Department of Pediatrics, Teikyo University School of Medicine, Tokyo, Japan
| | - Ichizo Nishino
- 4Medical Genome Center, NCNP, Tokyo, Japan.,5Department of Neuromuscular Research, National Institute of Neuroscience, NCNP, Tokyo, Japan
| | - Yu-Ichi Goto
- 1Department of Mental Retardation and Birth Defect Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.,4Medical Genome Center, NCNP, Tokyo, Japan
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Rae KM, Grimson S, Pringle KG. Personalised Medicine: A New Approach to Improving Health in Indigenous Australian Populations. Public Health Genomics 2017; 20:58-62. [PMID: 28056457 DOI: 10.1159/000455005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 12/08/2016] [Indexed: 11/19/2022] Open
Abstract
Personalised medicine is a newly emerging field with much to offer to all populations in improved clinical treatment options. Since the 1970s, clinicians and researchers have all been working towards improving the health of Indigenous Australians. However, there has been little research on the impact of genetics on Indigenous health, how genetic and environmental factors interact to contribute to poor health in Indigenous people, and how genetic factors specific to Indigenous people affect their responses to particular treatments. This short review highlights the urgent need for more genetic studies specific to Indigenous people in order to provide more appropriate care and to improve health outcomes. This paper explores why genetic work with Indigenous communities has been limited, how personalised medicine could benefit Indigenous communities, and highlights a number of specific instances in which personalised medicine has been critical for improving morbidity and mortality in other high-risk groups. In order to take the next step in advancing the health of Indigenous peoples, targeted research into the genetic factors behind chronic diseases is critically needed. This research may allow clinicians a better understanding of how genetic factors interact with environmental factors to influence an Indigenous Australian's individual risk of disease, prognosis, and response to therapies. It is hoped that this knowledge will produce clinical interventions that will help deliver clearly targeted, more appropriate care to this at-risk population.
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Affiliation(s)
- Kym M Rae
- Gomeroi gaaynggal Centre, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW, Australia
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Sankar P, Cho MK, Monahan K, Nowak K. Reporting Race and Ethnicity in Genetics Research: Do Journal Recommendations or Resources Matter? Sci Eng Ethics 2015; 21:1353-1366. [PMID: 25407312 DOI: 10.1007/s11948-014-9596-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 09/15/2014] [Indexed: 06/04/2023]
Abstract
Appeals to scrutinize the use of race and ethnicity as variables in genetics research notwithstanding, these variables continue to be inadequately explained and inconsistently used in research publications. In previous research, we found that published genetic research fails to follow suggestions offered for addressing this problem, such as explaining the basis on which these labels are assigned to populations. This study, an analysis of genetic research articles using race or ethnicity terms, explores possible features of journals that are associated with improved reporting of race and ethnicity in genetic research. A journal's expressed commitment to improving how race and ethnicity are used in genetic research, demonstrated by an editorial or in its instructions to authors, was the strongest predictor of following recommendations about reporting race and ethnicity. Journal impact factor had only a limited positive effect on attention to these issues, suggesting that editorial resources associated with higher impact factor journals are not sufficient to improve practices. Our findings reiterate that race and ethnicity variables are used inconsistently in genetic research, but also shed light on how journals might improve practices by highlighting the need for scientists to carefully scrutinize the use of these variables in their work.
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Affiliation(s)
- Pamela Sankar
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA.
| | - Mildred K Cho
- Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Modular A, Stanford, CA, 94305-5417, USA.
| | - Keri Monahan
- Department of Medical Ethics and Health Policy, University of Pennsylvania, 3401 Market Street, Suite 320, Philadelphia, PA, 19104, USA.
| | - Kamila Nowak
- Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA, 19107, USA.
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Wynn J, Martinez J, Duong J, Zhang Y, Phelan J, Fyer A, Klitzman R, Appelbaum PS, Chung WK. Association of Researcher Characteristics with Views on Return of Incidental Findings from Genomic Research. J Genet Couns 2015; 24:833-41. [PMID: 25592144 DOI: 10.1007/s10897-014-9817-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
Whole exome/ genome sequencing (WES/WGS) is now commonly used in research and is increasingly used in clinical care to identify the genetic basis of rare and unknown diseases. The management of incidental findings (IFs) generated through these analyses is debated within the research community. To examine how views regarding genomic research IFs are associated with researcher characteristics and experiences, we surveyed genetic professionals and assessed the effect of professional background and experience on their opinions. Researchers who did not have clinical training, provide clinical care to research participants, or have prior experience returning research results were in general more inclined to offer return of IFs than their colleagues with these characteristics. Understanding this will be important to fully appreciate the impact that policies on return of genetic IFs could have on participants, researchers, and genomic research.
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Affiliation(s)
- Julia Wynn
- Department of Pediatrics, Columbia University Medical Center, 1150 St. Nicholas Ave., Russ Berrie Pavilion, 6th Fl, Rm 620, New York, NY, 10032, USA.
| | - Josue Martinez
- Department of Pediatrics, Columbia University Medical Center, 1150 St. Nicholas Ave., Russ Berrie Pavilion, 6th Fl, Rm 620, New York, NY, 10032, USA
| | - Jimmy Duong
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Yuan Zhang
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Jo Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Abby Fyer
- Department of Psychiatry, Columbia University Medical Center and NY State Psychiatric Institute, New York, NY, USA
| | - Robert Klitzman
- Department of Psychiatry, Columbia University Medical Center and NY State Psychiatric Institute, New York, NY, USA
| | - Paul S Appelbaum
- Department of Psychiatry, Columbia University Medical Center and NY State Psychiatric Institute, New York, NY, USA
| | - Wendy K Chung
- Department of Pediatrics, Columbia University Medical Center, 1150 St. Nicholas Ave., Russ Berrie Pavilion, 6th Fl, Rm 620, New York, NY, 10032, USA. .,Department of Medicine, Columbia University Medical Center, 1150 St. Nicholas Ave., Russ Berrie Pavilion, 6th Fl, Rm 620, 10032, New York, NY, USA.
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